Chimney technique in the endovascular repair of juxtarenal abdominal aortic aneurysm

Endovascular aneurysm repair is dependent on satisfactory proximal and distal sealing zones.Compromised proximal necks between the renal arteries and aneurysm may pose challenges to achieving a seal proximally. Techniques to extend this sealing zone proximally to healthier aorta include fenestrated and branched grafts which are not readily available particularly for emergent cases. The chimney technique involves preserving vital aortic branches with covered stents from the target vessels, running parallel to an aortic stent graft deliberately positioned above their ostia. This technique is described and illustrated with the aid of a case presentation.